Surge capacity versus surge capability in nursing and health system preparedness: a scoping review

Health systems increasingly face pandemics, mass casualty incidents, and mass gatherings that overwhelm their routine operations. Preparedness planning is dominated by surge capacity, a system’s ability to expand beyond usual services to absorb a sudden rise in demand, while surge capability, the ability to deliver specialized or complex care under those same conditions, has received far less conceptual attention. This review mapped how surge capacity and surge capability have been defined, differentiated, and applied in nursing and health system preparedness, the nursing competencies that underpin them, and the potential implications of treating the two constructs as interchangeable. A scoping review was conducted following the Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR checklist. No protocol was registered. Title and abstract screening, full-text eligibility assessment, data charting, and synthesis were all undertaken by a single reviewer. The eligibility criteria were piloted, full-text exclusions were re-examined, and every record-level decision was documented in an auditable screening log; these measures are not equivalent to independent duplicate screening, and the design may have increased the risk of selection, extraction, and interpretive error. Five databases (PubMed/MEDLINE, CINAHL, Embase, Scopus, and Web of Science) were searched on June 15, 2026, for English-language sources published between 2000 and 2026, supplemented by citation searching and grey literature sources. Eligibility followed the Population–Concept–Context framework, including empirical studies of any design, concept analyses, reviews, consensus documents, and grey literature. Data were charted with a piloted instrument and analyzed descriptively; consistent with scoping methodology, quality was not appraised. Of 156 unique records screened (664 identified from databases and two through citation searching; 510 duplicates removed), 97 full texts were assessed and 23 sources published between 2006 and 2025 were included: nine addressed the definition and evolution of surge capacity, six differentiated capability from capacity, and ten synthesized nursing competencies, with two sources contributing to two objectives. Surge capacity showed a stable definitional core that evolved through the component, stratification, and adaptive phases, yet remained quantitative and structural. No dedicated concept analysis, framework, or measurement instrument for surge capability was identified among the sources meeting this review’s eligibility criteria and retrieved through the executed search, although national preparedness doctrine pairs the two terms operationally without developing capability as a construct; only one historical review explicitly paired the two constructs, and the distinction was otherwise derived from the health systems resilience literature. Competency evidence indicates that capability may be buildable through training, although this rests on a single uncontrolled evaluation; that self-assessed competence is unreliable; and that the construct now extends to nurse-leader competencies. This literature has developed in parallel with, rather than integrated into, surge frameworks. Three potential implications of conflating the two constructs emerged from the synthesis, bearing on preparedness measurement, comparability across settings, and workforce planning; none was examined directly by an included source. The synthesis suggests that organizations may be capacity-rich but capability-poor, and that prevailing volume-based metrics would not detect this gap; no included source tested this relationship directly. A dedicated concept analysis of surge capability and a validated capability instrument anchored in existing psychometric nursing competency work are priorities for preparedness research, leadership, education, and policy. These conclusions are conceptual rather than causal: they map the state of a literature and set a research agenda, and they were derived from a single-reviewer scoping review of English-language sources in which methodological quality was not appraised.